Z90.11: Acquired absence of right breast and nipple
Z90.11, acquired absence of right breast and nipple, is listed as a covered diagnosis in 3 Medicare billing and coding articles that apply to 9 HCPCS Level II codes, including L8035 (Custom breast prosthesis, post mastectomy, molded to…), L8002 (Breast prosthesis, mastectomy bra, with integrated breast…), L8001 (Breast prosthesis, mastectomy bra, with integrated breast…). 6 of these codes have a 2026 DMEPOS fee schedule amount; L8035 pays $4,403.11 to $5,283.69 depending on the state. The articles come from 2 Medicare contractors. A listed diagnosis supports medical necessity only; coverage still depends on the LCD's criteria and on documentation in the medical record.
HCPCS Level II codes with Z90.11 as a covered diagnosis
| Code | Description | Medicare coverage | DMEPOS fee 2026 (state range) | Articles listing it |
|---|---|---|---|---|
| L8035 | Custom breast prosthesis, post mastectomy, molded to patient model, any type | Special coverage instructions apply | $4,403.11–$5,283.69 | 1 |
| L8002 | Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, bilateral, any size, any type | Special coverage instructions apply | $198.27–$218.12 | 1 |
| L8001 | Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, unilateral, any size, any type | Special coverage instructions apply | $150.77–$165.83 | 1 |
| L8015 | External breast prosthesis garment, with mastectomy form, post mastectomy | Special coverage instructions apply | $72.05–$86.41 | 1 |
| L8000 | Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type | Special coverage instructions apply | $44.70–$78.16 | 1 |
| A4280 | Adhesive skin support attachment for use with external breast prosthesis, each | Carrier judgment | $7.38–$8.13 | 1 |
| Q2028 | Injection, sculptra, 0.5 mg | Special coverage instructions apply | — | 2 |
| G0429 | Dermal filler injection(s) for the treatment of facial lipodystrophy syndrome (lds) (e.g., as a result of highly active antiretroviral therapy) | Carrier judgment | — | 2 |
| Q2026 | Injection, radiesse, 0.1 ml | Special coverage instructions apply | — | 2 |
Medicare policy articles listing Z90.11
- A52478: External Breast Prostheses - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC); 6 Level II codes). LCD with the same title: L33317
- A59299: Billing and Coding: Cosmetic and Reconstructive Surgery (CGS Administrators, LLC (MAC - Part A, MAC - Part B); 3 Level II codes). LCD with the same title: L33428, L35090, L38914, L39051
- A58774: Billing and Coding: Cosmetic and Reconstructive Surgery (WPS Insurance Corporation (MAC - Part A, MAC - Part B); 3 Level II codes). LCD with the same title: L33428, L35090, L38914, L39051
A diagnosis listed as covered in a billing and coding article supports medical necessity for the article's codes; it does not guarantee payment. Coverage depends on the LCD's criteria, the contractor's jurisdiction and documentation in the medical record.
Other Z90 diagnoses (Acquired absence of organs, not elsewhere classified)
- Z90.12 — Acquired absence of left breast and nipple
- Z90.13 — Acquired absence of bilateral breasts and nipples
- Z90.79 — Acquired absence of other genital organ(s)
Frequently asked questions
Does Medicare cover Z90.11 (Acquired absence of right breast and nipple)?
Medicare covers items and services, not diagnoses. 3 Medicare billing and coding articles list Z90.11 as a covered diagnosis for 9 HCPCS Level II codes: the diagnosis can support medical necessity for those codes, but payment still depends on the LCD's coverage criteria and the medical record.
Which HCPCS codes can be billed with ICD-10 Z90.11?
The Level II codes from the policies most specific to this diagnosis are L8035 (Custom breast prosthesis, post mastectomy, molded to…, 1 article); L8002 (Breast prosthesis, mastectomy bra, with integrated breast…, 1 article); L8001 (Breast prosthesis, mastectomy bra, with integrated breast…, 1 article); L8015 (External breast prosthesis garment, with mastectomy form…, 1 article); L8000 (Breast prosthesis, mastectomy bra, without integrated…, 1 article). Code choice depends on the item supplied; check each code's descriptor.
What does Medicare pay for equipment billed with Z90.11?
Under the 2026 DMEPOS fee schedule (non-rural state fees): L8035 $4,403.11 to $5,283.69; L8002 $198.27 to $218.12; L8001 $150.77 to $165.83; L8015 $72.05 to $86.41. Medicare pays 80% of the allowed amount after the Part B deductible.
Which Medicare policy articles list Z90.11?
A52478 (External Breast Prostheses - Policy Article); A59299 (Billing and Coding: Cosmetic and Reconstructive Surgery); A58774 (Billing and Coding: Cosmetic and Reconstructive Surgery).
What is ICD-10-CM code Z90.11?
Z90.11 is the ICD-10-CM code for acquired absence of right breast and nipple, in category Z90 (Acquired absence of organs, not elsewhere classified), chapter 22: Factors influencing health status and contact with health services.
Next steps
- Run a reimbursement report for a device billed under L8035
- Watch L8035 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L8035
Sources: CMS Medicare Coverage Database billing and coding articles (covered ICD-10 code lists and HCPCS links); ICD-10-CM FY2026; CMS HCPCS Level II release October 2026; CMS DMEPOS fee schedule 2026 (non-rural state fees). Not billing or legal advice.
Chapter 22: Factors influencing health status and contact with health services · All diagnoses · HCPCS lookup